Laparoscopic treatment of ovarian dermoid cysts: Eleven years' experience

Study Objective. To compare laparoscopic and open approaches in the management of benign ovarian teratomas (dermoid cysts) with regard to operative outcome, complications, and postoperative follow-up. Factors that predispose to rupture of dermoid cysts during laparoscopic removal and rates of adhesion formation in women with and without cyst rupture during laparoscopic surgery also were considered. Design. Review of cases of women with dermoid cysts who underwent cystectomy either by laparoscopy or laparotomy in our department from 1992 through 2002 (Canadian Task Force classification III). Setting. The Infertility and Operative Laparoscopy units of the First Department of Obstetrics and Gynecology of the University of Athens, Alexandra Maternity Hospital, Athens, Greece. Patients. Two hundred twenty-two women with an ovarian mass requiring surgical management. Of these, 787 women with benign cystic teratomas underwent laparoscopic cystectomy, and 35 underwent cystectomy by laparotomy. Interventions. Cystectomy either by laparoscopy or laparotomy. Measurements and Main Results. Potential benefits of operative laparoscopy include reduced blood loss, less postoperative pain, shorter hospital stay, fast recovery, and an excellent cosmetic result. Conclusion. Laparoscopy should be considered the method of choice for the removal of benign ovarian cystic teratomas as it offers the advantages of fewer postoperative adhesions, reduced pain, shorter hospital stay, and better cosmetic result. It should be performed by surgeons with considerable experience in advanced laparoscopic surgery

Urokinase-type plasminogen activator and insulin-like growth factor-binding protein 3 mRNA expression in endometriotic lesions and eutopic endometrium: Implications for the pathophysiology of endometriosis

The peritoneal fluid of women with endometriosis contains an increased insulin-like growth factor 1 (IGF-1) bioavariability, which is produced by limited hydrolysis of urokinase-type plasminogen activator (uPA) on IGF-binding protein 3 (IGFBP-3). Recently, IGF-1 was shown to inhibit apoptosis of endometrial-like cells in vitro, suggesting that a microenvironment of increased IGF-1 bioavailability can optimize the survival of endometrial cells grown ectopically. Here the expression of mRNA of IGFBP-3 and uPA in tissue biopsies from eutopic endometrium and endometriotic lesions obtained at laparoscopy from women with endometriosis have been analyzed, and it is documented that both IGFBP-3 and uPA mRNA expression are increased from 3- to 10-fold in endometriotic lesions versus eutopic endometrium. Consequently, the necessary components (uPA and IGFBP-3 expression) of endocrine/autocrine/paracrine enhancement of local IGF bioavailability mediated by uPA hydrolysis of the IGFBP-3 were present in endometriotic lesions. These data possibly explain the origin of the increased content of uPA activity, IGF-1 bioavailability, and NH2-truncated forms of IGFBP-3 in the peritoneal fluid of women with endometriosis

Leptin in human reproduction

The recent discovery of the obese (ob) gene has provided new insight into the mechanism which controls body fat mass. Leptin, a product of the ob gene, serves as the link between fat and the brain. This protein, by acting at the level of the hypothalamus, decreases food intake and increases energy expenditure. Animals that lack leptin (ob/ob mice) develop profound obesity and become infertile, Treatment of these animals with leptin reduces food intake and restores normal fertility; Although leptin is important for the control of fat stores in certain species, the role of this substance in the de development of human obesity remains obscure, However, it has been speculated that, in humans, obesity is related to leptin resistance. The relationship between fat and reproduction has been recognised for >20 Sears. This article discusses the relationship between leptin and human reproduction, Tn particular, recent knowledge about the possible role of leptin in various conditions such as puberty, polycystic ovary syndrome and pregnancy is reviewed, Also, the article discusses the possible role of leptin in ovarian function and the relationship of this protein with gonadal steroids. It is expected that future research will clarify the physiological importance of leptin in human reproductive function

Laparoscopic management of patients with endometriosis and chronic pelvic pain

Endometriosis has been traditionally included among the most important causes of chronic pelvic pain (CPP) in women of reproductive age. The main clinical manifestations of endometriosis are dysmenorrhea, dyspareunia, and chronic nonmenstrual pain. Despite the high prevalence of endometriosis in women suffering from CPP, controversy still exists regarding the true association between the stage and extent of this peculiar disease and the severity of pain. Over the last decade, advances in endoscopic technology have enabled gynecologic surgeons to recognize many atypical appearances of the endometriotic implants not known to exist before, thus allowing their complete excision or destruction. Laparoscopic surgery may offer considerable relief in patients with endometriosis and CPP. Although cases with advanced endometriosis seem to benefit the most, we also support surgical treatment in patients with early endometriosis diagnosed using laparoscopy, as many will experience improvement in their symptoms

Current and future status of ovulation induction in polycystic ovary syndrome

Great progress has been achieved during the last 20 years in the field of ovulation induction in patients with polycystic ovary syndrome (PCOS). Clomiphene citrate remains the first line of treatment for all anovulatory women with PCOS, since in properly selected patients the cumulative pregnancy rate approaches that in normal women, Human urinary gonadotrophins have been used extensively for ovulation induction, but the development of low-dose regimens has opened a new era in the management of anovulation related to PCOS, This article discusses the main advantages and disadvantages of the principal methods and regimens currently used for ovulation induction in patients with PCOS including clomiphene citrate, gonadotrophins, pulsatile gonadotrophin-releasing hormone (GnRH) and GnRB agonists, It also discusses new drugs discovered recently, particularly recombinant gonadotrophins and GnRH antagonists, and provides some thoughts regarding their use in future protocols, Finally, based on the discovery of new ovarian substances which specifically control luteinizing hormone (LH) secretion, this article develops assumptions on possible implications of these substances in the pathophysiology of PCOS and their potential use in the management of the syndrome

Asymptomatic cholelithiasis: Is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy

Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints. About 10-20% of people in most western countries have gallstones, and among them 50-70% are asymptomatic at the time of diagnosis. Asymptomatic gallstone disease has a benign natural course; the progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%. The majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain ("colic"). In the prelaparoscopy era, (open) cholecystectomy was generally performed for symptomatic disease. The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis. Despite some controversy, most authors agree that the vast majority of subjects should be managed by observation alone (expectant management). Selective cholecystectomy is indicated in defined subgroups of subjects, with an increased risk for the development of gallstone-related symptoms and complications. Concomitant cholecystectomy is a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions. Routine cholecystectomy for all subjects with silent gallstones is a too aggressive management option, not indicated for most subjects with asymptomatic cholelithiasis. An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual subject with silent gallstones. Management options should be extensively discussed with the patient; he or she should be actively involved in the process of therapeutic decision making. © 2007 Springer Science+Business Media, Inc

Hydrosalpinx treatment: Comparison between laparoscopy and laparotomy

Distal tubal obstruction continues to be a common cause of infertility. The choice of surgical or in vitro fertilization approach is still ambiguous. During the period January 1990 to June 1999, 144 cases of bilateral neosalpingostomy and restoration of the tubal-ovarian anatomy were carried out in our institution. In 61 cases, the neosalpingostomies were performed laparoscopically and, in the remaining 83, by microsurgery. After treatment, all patients attempted to conceive, and at the end of the 24-month follow-up, 21 (25%) and seven (8.4%) from the laparotomy group and 14 (23%) and two (3.3%) from the laparoscopy group have, respectively, achieved intrauterine and extrauterine pregnancies. In both groups, most pregnancies occurred during the first postoperative year. Pregnancies were achieved in all stages of the disease in the laparotomy group, while in the laparoscopy group no pregnancy was achieved in the severe stage. Hysterosalpingographies performed 2 years after in non-pregnant patients showed that both tubes were patent in all women with mild tubal disease without adhesions in both groups. In women with mild disease and adhesions, 80% and 70% of the operated by laparoscopy and microsurgery, respectively, had patent tubes. In the group of moderate disease, 60% and 70% of the treated by laparoscopy and laparotomy had one or both of their tubes patent. All women with severe disease had, after the laparoscopy, closed tubes, and only in 20% of the operated with microsurgery had one or both tubes patent. Reconstructive surgery of the hydrosalpinges of mild or even moderate stage either laparoscopically or by microsurgery is an effective approach in treating infertility due to distal tubal occlusion. Moreover, the opening of the tubes may improve the IVF results